Forging a Patient-Centric Path to Revolutionize and Redefine Value-Based Care

Transforming data utilization, incorporating comprehensive clinical expertise, and improving the patient journey and treatment management are at the heart of a patient-focused partnership between Optum Life Sciences and Takeda Pharmaceuticals that aims to innovate positive change in the value-based care landscape for patients with inflammatory bowel diseases (IBDs) by using digital modalities and data differently and more effectively.

Erin Hulbert, MBA, MS | Image Credit: Optum Life Sciences

Joining moderator Erin Hulbert, MBA, MS, director of value-based contracting services at Optum Life Sciences, part of UnitedHealthcare Group, for the discussion, “Challenging the Quo: The Road to Value-Based Healthcare,”¹ at AXS24, the 20th Asembia summit, were Olivia Banyon, vice president, Optum Clinical Enterprise Programs, Optum Life Sciences; and Sean McCabe, vice president, Inflammatory Bowel Disease Franchise Head, Takeda Pharmaceuticals.

Partnerships between payers, health care providers, and pharmaceutical manufacturers are vital if value-based care is to succeed in the current health care landscape, the trio agreed. These collaborations between clinical and administrative stakeholders help to not only continue the mission of value-based care—to ensure high-quality care while reducing the total cost of that care²—but to raise its bar for data utilization, real-world evidence generation, communication, and clinical decision-making through the alignment of shared values and key drivers of health care delivery that consider both patient outcomes and provider needs. It’s about both identifying opportunities and leaving well enough alone.

Olivia Banyon, MPH | Image Credit: Optum Life Sciences

“Value-based care is an effort to improve health care delivery, patient outcomes, and optimize health care spend across the different stakeholders,” Hulbert reminded the audience. “And while this trend really brings some opportunities for partnerships, it does mean that we have to work together from our different perspectives and find some common ground.”

Both organizations have a long-term view of where to implement and how to facilitate multidisciplinary care solutions that address variability in care, empower providers to deliver whole-patient care, and streamline care coordination. Together, their bottom line is to find patient-centered common ground that drives meaningful change for patients.

This collaborative mindset has several advantages compared with working as a siloed organization. Collaboration is proactive, can help to maximize the potential of value-based health care, leads to a synergistic effect for patients, and increases efficiency for health systems compared with working alone, which the presenters agreed was an outdated business model beset by persistent challenges.

Sean McCabe, MBA |Image Credit: Takeda Pharmaceuticals

Why IBD? It’s a high-burden progressive disease whose patients have an elevated risk of developing colon cancer and eventual need of bowel resection surgery, so there is a lot left to optimize to address gaps in the patient journey, both in treatment and disease management, McCabe explained, reflecting the partnership’s mission to provide high-quality care, personalize care delivery, and leverage data and technology to push progress in value-based care, to challenge the current status quo on care delivery.

“It’s about designing new systems to deliver on value-based care,” Banyon reiterated. “Giving providers a choice and allowing them to make the best clinical decision. Value-based care has been around for a while, so while the concept is not new, there is a need to design new ways to deliver on value-based care. It’s the way that we can operationalize it that is new.”

Especially within the IBD space, there is a lot of latitude around and variability with choice that can yield significantly different outcomes for patients, and that lends itself to opportunity for change and progress. Namely, helping physicians spend more time evaluating what is the best clinical decision for a patient by providing them with the best data, the best tools, and the best technologies to make full-picture integrated evaluations on demand more efficiently, Banyon added, because “we are responsible for the entire patient journey, and how that data are communicated to a provider and whether or not that provider is able to use it.”

How does the Optum/Takeda partnership demonstrate this commitment to taking value-based care to the next level? Both are committed to leveraging data, their combined digital resources, and technology to collaborate on and codevelop an IBD virtual care pilot program, with Optum bringing to the table its payer and provider care model and Takeda its expertise and resources in IBD.

Exploring this pathway to improving care delivery and outcomes for patients with IBDs encompasses 4 phases, each building on the results of the previous phase to get to the patients where and when they need care, and to supplement the care they receive in a more timely manner.

“We’ve developed an insight framework to understand what the opportunities are obviously to drive therapeutic value and clinical expertise as well, to ask what are people organically trying to fix,” McCabe explained. “This is a hybrid disease that’s driven off a lot of challenges. This is a very collaborative format.”

Phase 1 involves analysis, gathering data on baseline population operational metrics and care delivery organization workflows. From there, phase 2’s design goal is to fashion the virtual care delivery methodology and the partnership’s analytics and outcomes plan. Execution in phase 3 is when the program goes live, along with its management and assessment. Phase 4 will have a baseline comparison and refinement of program components as necessary.

Together, the 2 specialty pharmacy industry giants will have an ongoing look at their invested partnership, its potential outcomes, and operational improvements they may need to consider.

“We have insights and we have visibility into what I would deem the suboptimal journey through someone's disease, just by nature of what we invest in from an insights platform. You have to understand the disease, the disease journey, the patient journey,” McCabe said. “No longer are we just looking at data and identifying what is suboptimal. We’re partnering with an organization that’s willing and able to create that intervention we never had the potential to do.”

There’s a lot more than can be done to drive value in the value-based care space, the panelists agreed, and having the knowledge gained through collaboration and partnership is the only way to access the insight you need to facilitate and support personalized whole-patient care.

References

1. Challenging the quo: the road to value-based healthcare. Presented at AXS24; April 28-May 2, 2024; Las Vegas, NV. https://asembia2021.egnyte.com/fl/u6bmUePsTR#folder-link/AXS24%20Session%20Slides?p=cfe356d8-57cf-4064-9cdb-e937e9582bda

2. Value based payment models. American Physical Therapy Association. Accessed April 30, 2024. https://www.apta.org/your-practice/payment/value-based-payment-models#:~:text=Value-based%20payment%20models%20use,to%20success%20in%20these%20models